Basic Information
| Provider Information | |||||||||
| NPI: | 1588114474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHELTON | ||||||||
| FirstName: | ANJELICIA | ||||||||
| MiddleName: | TEREZ | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 HIGHWAY 80 | ||||||||
| Address2: | |||||||||
| City: | CHOUDRANT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712273202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185375176 | ||||||||
| FaxNumber: | 3182742191 | ||||||||
| Practice Location | |||||||||
| Address1: | 9403 MANSFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188618938 | ||||||||
| FaxNumber: | 3188623554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.